Pharmacies

How Digital Transformation Can Help Patient Adherence

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How a community pharmacy can stay ahead of the curve by leveraging advancements in technology.

Every community pharmacy wants to increase medication adherence across their patients despite limitations of time or budget. With the impressive strides made in technological advancements and digital connectivity, a modern approach for taking advantage of current technologies has emerged for independent pharmacies. Adopting new advances is important for independent community pharmacies looking to stay ahead of the curve when it comes to improving patient care, adherence and retention.

The rising cost of healthcare climbs steeper with non-adherence

Over the past two decades, healthcare costs have increased exponentially. A number of factors are driving these massive cost spikes, most notably the aging population and chronic diseases such as diabetes, hypertension and chronic pain. Prescription drugs make up a big chunk of these rising costs. Half of the $101 billion spent on diabetes in 2013, for example, was for medications1.  

However, many patients afflicted with these conditions struggle to stick to their medication regimens. More than half of all prescriptions for chronic diseases are not taken as directed.2 Another 20 to 30 percent of those prescriptions are never filled. Over time, adherence to medication protocols falls off in virtually every class of drugs, hitting 20 percent after one year in some cases.3 These factors drive worsening health outcomes, exerting upward pressure on costs as patients often end up sicker after skipping medication doses.

Could digital technology alter the course of non-adherence?

Digital technologies such as mobile apps, sensors, wearables, conversational AI and smart labels can improve health outcomes and decrease cost escalations. The most effective approach to using technology for enhanced outcomes is to take a multi-faceted approach to engage patients. For example, technology that provide alerts and tracks conditions and therapies should be combined with peer support or caregiver involvement allowing medical professionals to better manage against nonadherence.

According to the New England Healthcare Institute, poor adherence to treatment regimens contributes as much as $290 billion annually in avoidable medical costs.4 What’s more, medication nonadherence is the leading cause of preventable morbidity and mortality.5 It’s thought to account for 30 to 50 percent of treatment failures and 125,000 deaths annually, according to the American College of Preventive Medicine.6 With the promise of digital technology could help change this trajectory.

Here are four advancements in digital technology that could offer significant benefit for community pharmacy:

1. Digital therapeutics
Patients skip their medications for a variety of reasons. Topping the list is fear of potential side effects and the cost of prescription drugs.7 Yet, the reasons don’t stop there. A patient’s illness, ailment or symptom doesn’t always respond to prescribed medications immediately, which causes the patient to believe they are not working or they don’t need them. Patients may be confused about how to properly administer medication, fail to prioritize treatment, or experience psychological resistance to the prescribed regimen.

The medical industry is responding by implementing a number of technology-based strategies to encourage patients to take every last pill prescribed to them. The Harvard Business Review calls these strategies “digital therapeutics,” or technology-based solutions that can have a significant clinical impact.8 Capturing data with mobile devices and sensors, these technologies can deliver predictive and real-time alerts and information through web browsers, apps and medical devices.

As the cost of sensors continues to plunge, companies are experimenting with smart packaging and pill dispensers that remind patients to take their medications.9 These devices alert patients with sounds or flashing lights. Some of them even dispense the medication and record the event. Some companies are developing pills with ingestible sensors that track compliance as well as the effects of medications on the patient.10

2. Wearable technology
Promising solutions for medication adherence may reside with wearable technology. Patients along with broad segments of the population have warmed to wearables in recent years as the wide adoption of devices such as Fitbit, Apple Watch and Samsung Gear demonstrate. Results from an Accenture Patient Engagement Survey reveal that 49 percent of patients around the world wear—or are open to wearing—devices that track physical activity and vital signs.11 Over the last two years the use of health wearables has more than doubled, from 9 percent in 2014 to 21 percent in 2016. While the use of health care apps has surged over the same period, from 16 percent of users to 33 percent.12

These technologies can track everything from steps to heart rates to skin temperature and blood oxygenation, and can potentially alert wearers to the efficacy of their medications. Wearables can drive adherence behaviors by automatically detecting when medicine is taken or not taken, for example, and by sending alerts to users.

When integrated into medical systems, wearable devices—from smart glasses to wrist displays to a variety of connected sensors—can lead to better health outcomes, efficiency and lower costs.

And patients and the public are taking notice. The market for wearables is expected to catapult from an estimated $7.1 billion in 2015 to 12.6 billion by 2018.13 Global shipments of health wearables, racking up 13 million units in 2013, expanded to 34 million units in 2015. 

3. Mobile applications
A solution that shows much promise in the challenging environment of medication adherence is smartphone and tablet apps. Intuitive apps empower patients to self-manage their medication regimens and appointment schedules from their mobile or tablet devices. When connected to cloud-based platforms, these technologies allow physicians and pharmacists to communicate with patients to clarify their understanding of conditions, complex drug regimens, and potential side effects. 

This is why apps for smartphones and tablets are fast becoming the most effective and widely adopted tools for health and physical well being. According to the Journal of Anaesthesiology Clinical Pharmacology, more than 20,000 mobile apps linked to healthcare, fitness and medicine were available by the end of 2015.14

These applications include reminders for taking and refilling medications, and alerts for doctor or pharmacy appointments. Calendar-based alarms can alert patients to take required medication dosages at specific times of day, track the time of their last dosage, and record regular procedures such as blood pressure checks and blood workups. Apps can also include options to integrate medication lists with pharmacy contact information. Some include medication facts and can proactively query patients about side effects, allowing patients to record how they’re feeling. Others even include virtual “pillboxes” with images displaying the size and shape of pills for easy identification to avoid confusion.

When connected with sensors (and clinical personnel) combined with artificial intelligence and data analytics, these apps can potentially detect and intervene during episodes of clinical depression or coronary or respiratory conditions.

4. Voice Recognition
Voice recognition systems such as Google Home and Amazon Alexa have the potential to transform healthcare. With these systems, patients can book appointments, request medication refills from the pharmacy, be reminded to take medications, and track their intake of food.15 It could also answer questions about a patient’s condition, symptoms, and medications, and be used to call for help in emergency situations.

Boston Children’s Hospital developed an Alexa-based app early last year that provides parents with advice on how to care for a child with a fever. Dubbed the KidsMD app, the technology provides actionable health information while it collects data about symptoms and locations that could give public health professionals early warning signs of flu outbreaks.

Amazon hopes to drive innovations further with its voice recognition technology. In 2015, the online retailer announced the Alexa Fund, a $100 million investment pool that supports developers, manufactures, and startups focused on creating new voice recognition capabilities.16 Voice technology could someday soon enable pharmacists to easily restock medications, contact patients and physicians, and check medication availability from distributors. Doctors, nurses, pharmacists, patients and caregivers could soon leverage the Alexa paradigm to streamline healthcare delivery across the entire system.

Pharmacist-patient digital engagement

These technologies mean that independent retail pharmacies with established networks can reap significant benefits by engaging with pharmacy-driven apps (apps set up by pharmacists).17 They can facilitate regular interactions between pharmacists and patients while encouraging them to visit the pharmacy more often. In addition, apps can prompt patients to have additional prescriptions filled at the pharmacy. These technologies can provide pharmacists with a critical competitive advantage in today’s turbulent healthcare market.   

The key to ensuring patients to adhere to treatment plans is to make it easy for them to do so. Helping patients explore how the tools they use in their daily routines — from smartphones and tablets to wearables and smart TVs — can improve their health will drive better health and cost outcomes across the healthcare continuum. 



References:
1. Johnson, C.Y. (2016, December 27). The U.S. Spends More on Health Care Than Any Other Country. Here’s What We’re Buying. Retrieved January 24, 2017, from The Washington Post, http://www.washingtonpost.com/news/wonk/wp/2016/12/27/the-u-s-spends-more-on-health-care-than-any-other-country-heres-what-were-buying/?utm_term=.cec85b77c298
2. Fogel, A.L., Kvedar, J.C. (2016, November 14). Simple Digital Technologies Can Reduce Health Care Costs. Retrieved January 24, 2017, from Harvard Business Review, http://hbr.org/2016/11/simple-digital-technologies-can-reduce-health-care-costs
3. Morrow, T. (2016, April 15). Can Medication Packaging Promote Adherence? Retrieved January 24, 2017, from Managed Health Care Connect, http://www.managedhealthcareconnect.com/articles/can-medication-packaging-promote-adherence-0
4. Thinking Outside the Pillbox: A System-Wide Approach to Improving Patient Medication Adherence for Chronic Disease. (2009, August). Retrieved February 3, 2017, from New England Healthcare Institute, http://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf 
5. Adherence to Long-Term Therapies: Evidence for Action. (2003, January). Retrieved February 3, 2017, from World Health Organization, http://www.who.int/hiv/pub/prev_care/lttherapies/en
6. Medication Adherence Clinical Reference. (2011). Retrieved January 24, 2017, from American College of Preventive Medicine, http://www.acpm.org/?MedAdherTT_ClinRef
7. 8 Reasons Patients Don’t Take Their Medications. (2015, October 16). Retrieved January 24, 2017, from American Medical Association, http://wire.ama-assn.org/practice-management/8-reasons-patients-dont-take-their-medications
8. Fogel, A.L., Kvedar, J.C. (2016, November 14). Simple Digital Technologies Can Reduce Health Care Costs. Retrieved January 24, 2017, from Harvard Business Review, http://hbr.org/2016/11/simple-digital-technologies-can-reduce-health-care-costs
9. Morrow, T. (2016, April 15). Can Medication Packaging Promote Adherence? Retrieved January 24, 2017, from Managed Health Care Connect, http://www.managedhealthcareconnect.com/articles/can-medication-packaging-promote-adherence-0
10. Hewlett, A. (2016, July 17). The Potential of Smart Pills and Ingestible Sensors. Retrieved January 24, 2017, from Pharmacy Times, http://www.pharmacytimes.com/contributor/austin-hewlett-pharmd-mba-candidate/2016/07/the-potential-of-smart-pills-and-ingestible-sensors
11. Enhancing Clinical Practice With Wearables: Innovations and Implications. (2015). Retrieved January 24, 2017, from Accenture, http://www.accenture.com/t20160519T051015__w__/us-en/_acnmedia/PDF-19/Accenture-Wearables-Health-PoV.pdf
12. Accenture. (2016). Patients Want a Heavy Dose of Digital. Retrieved April 10, 2017, from https://www.accenture.com/_acnmedia/PDF-8/Accenture-Patients-Want-A-Heavy-Dose-of-Digital-Infographic-v2.pdf
13. Borukhovich, E. (2016, February 15). How Will Wearables Impact the Consumer Healthcare Marketplace? Retrieved January 24, 2017, from MedCity News, http://medcitynews.com/2016/02/wearables-and-healthcare/
14. Appold, K. (2016, January 29). Five Ways Technology Can Increase Patient Compliance. Retrieved January 24, 2017, from Managed Healthcare Executive, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/five-ways-technology-can-increase-patient-compliance 
15. Shah, N. (2016, September 5). How Amazon Echo can be helpful for the healthcare industry. Retrieved February 16, 2017, from Soft Web Solutions, http://www.softwebsolutions.com/resources/amazon-echo-app-development-for-healthcare.html
16. Amazon.com, Inc. (2015, June 25). Amazon Introduces the Alexa Fund: $100 Million in Investments to Fuel Voice Technology Innovation. Retrieved February 16, 2017, from Business Wire, http://www.businesswire.com/news/home/20150625005704/en/Amazon-Introduces-Alexa-Fund-100-Million-Investments 
17. Priyadarshini, A., Quinlan, M. (2016, May 17). Medication Adherence With Smart Phones: Pharmacists Focused Apps. Retrieved January 24, 2017, from Applied Research for Connected Health, http://www.arch.ie/wp-content/uploads/2016/05/Medication-Adherence-with-Smart-Phones_ARCH-Whitepaper1.pdf 
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